Coverage of Conditions and Treatments (Coverage Decisions)

Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.

List also available in PDF format.

Archived Coverage Decisions.

See Treatment Guidelines and Resources for additional information.

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Transcutaneous electrical nerve stimulation (TENS), interferential current therapy (IFC) and percutaneous neuromodulation therapy (PNT) devices for use outside of medically supervised facility settings are not covered for State Fund, Self-Insured and Crime Victims claims. This includes home use, purchase or rental of durable medical equipment (DME) and supplies. Use of these therapies will continue to be covered during hospitalization and in supervised facility settings.

Background Policy Information

On October 30, 2009, the State Health Technology Clinical Committee (HTCC) met in an open public meeting to review the evidence for Electrical Nerve Stimulation (ENS), including TENS, IFC and PNT, as treatments for acute and chronic pain. Based on a review of the best available evidence of safety, efficacy and cost-effectiveness, the committee’s determination is that ENS is noncovered for use outside of medically supervised facilities. Purchase or rental of TENS, IFC, and PNT equipment and supplies is not covered. The determination was made final by the HTCC on November 20, 2009.
Complete information on this HTCC determination is available at: What we're working on | Washington State Health Care Authority.

TENS/IFC/PNT Unit Rental and Purchase

Based on the HTCC decision, for workers covered by the Department of Labor and Industries State Fund and Self Insured employers, effective March 1, 2010, payment for existing ENS (includes TENS, IFC and PNT) device rentals or purchases will be discontinued.

  • Purchased ENS units already supplied (EMPI - purchase date prior to March 1, 2010) are owned by the injured worker. Supplies for purchased ENS units will no longer be reimbursed by the insurer.
  • For State Fund claims, rental units must be returned to the contracted supplier. To contact the supplier regarding existing TENS and IFC rental returns:
    EMPI, Inc.
    599 Cardigan Road
    St. Paul, MN 55126
    Phone: (800) 999-TENS, (800) 999-8367
    Fax: (800) 400-5022
  • For self-insured claims, contact the employer or their third party administrator (TPA) for ENS rental return assistance, if necessary.
Code Description Note
A4595 TENS Supp 2 lead per month Not covered
A4630 Replacement battery TENS owned by patient Not covered
E0720 TENS, 2 lead Not covered
E0730 TENS, 4 lead Not covered
S8130 IFC, 2 channel Not covered
S8131 IFC, 4 channel Not covered
Additional information